Inadequate organization systems or processes to improve safety and quality

Reader Comments

From Greek Goddess: “Re: Epic. As you’ve shared, its non-marketing department has done a good job of making operating margin and revenue growth part of the industry narrative, claiming causation with Epic’s EHR. You’ve been a voice of reason here, along with Wall Street and others – stating the obvious that the tide has risen for the entire industry under more reimbursed care under ACA and Medicaid coverage. The proposed Republican plan will cause 14 million people to lose coverage next year per the CBO. It will be interesting to see what Epic’s non-marketing department does to pin those falling margins on the competitors if that happens.” Perhaps Epic’s snazzy charts will show that their clients enjoyed less-dramatically reduced margins than those of their competitors. It’s meaningless anyway since, as is nearly always the case in healthcare, correlation is easy to observe but causation is nearly impossible to prove.

From RIF’ed Me a New One: “Re: Aetna. Several friends were let go yesterday and were told it was because of the failed Humana acquisition. I’m wondering if anyone else was affected?” I assume that if HIStalk readers are reporting it, it probably affected Aetna’s Medicity or iTriage groups. Anonymous reports on TheLayoff.com suggest that both Aetna and Humana have been paring headcount since the federal government turned the hose on their mating ritual.

From Slammed CIO: “Re: HIMSS17 unsolicited follow-ups. Vendors are contacting me claiming that I visited their booth at HIMSS17, ones I didn’t talk to then and have no need to talk with now. Has something changed at HIMSS? I’m curious if other attendees are having this experience.” I’ve received only a handful of emails, and while I don’t recall having visited the booths of a couple of the companies that sent them, I might well have allowed them to scan my badge so I could get a snack or lip balm or something.

From Julian Assuage: “Re: anonymous communications. How can I send you something with full anonymity?” My rumor report form is anonymous other than it captures your IP address, which is inherent in the form tool I use (although I don’t look at the IP address anyway). You could use Guerrilla Mail, which offers both disposable email addresses and the ability to send anonymous email without registering or paying. Either method supports adding attachments if you are inclined to provide supporting evidence.

From Pellegrino: “Re: Elaine Remmlinger of ECG. She was supposed to start a project with us and is retiring, effective immediately. It seems the reported bloodletting of the former Kurt Salmon employees is true.” ECG confirms that Elaine has retired as of Monday, but adds that she will probably be transitioning clients and projects for a few weeks.

HIStalk Announcements and Requests

We funded the DonorsChoose grant request of Ms. A in Illinois, who created a family involvement and social-emotional learning program for her community that is “plagued with low social-economic ills, gang infestation, and violence.” We provided VR headsets, geometry kits, robotics and electronic doodling pens, and other interactive tools to allow “virtual field trips.”

Aging programmer test – how many of the four long-obsolete programming languages above can you identify without Googling?

Acquisitions, Funding, Business, and Stock

The Hartford business paper profiles CareCentrix, which manages technology-powered post-acute care services for insurers. The company recorded $1.4 billion in revenue in 2016 in managing 23 million covered lives. CEO John Driscoll was formerly president of Castlight Health and was a Medco executive.

A federal court rules that the contracts of medical supply competitive bidding site Medpricer violate anti-kickback law since the company charges fees as a percentage of the dollar volume purchased. The federal judge determined that the company violated the law since federal healthcare programs could eventually be billed for the goods. Medpricer sued medical device maker Becton, Dickinson, and Co. for refusing to pay its 1.5 percent fee for three successful bids even though Becton had inserted language into its bid indicating that it would not pay any fees.

Announcements and Implementations

The National Patient Safety Foundation and the Institute for Healthcare Improvement will merge. IHI President and CEO Derek Feeley will lead the combined organizations.

Government and Politics

The President nominates Scott Gottlieb, MD to run the FDA. He is a venture partner, investment banker, and hedge funder advisor who sits on the boards of several drug companies and has advocated FDA de-regulation. He was FDA’s deputy commissioner for medical and scientific affairs from 2005 to 2007, director of medical policy development before that, and a member of the Health IT Policy Committee.

Trade association Health IT Now urges HHS Secretary Tom Price and Congress to review ONC’s regulatory role in health IT, citing ONC”s plans to review EHR product safety that are seemingly in conflict with FDA’s role and ONC’s “we’ll know it when we see it” certification process. Health IT is a non-profit group, but incorporated as a 501(c)(4) organization, meaning it can engage in political lobbying, endorse candidates, and make political donations. Health IT Now’s odd lot of members include drug companies and few second-tier healthcare associations, with notable dropouts over the years that I noticed in comparing old vs. new member lists being the American Academy of Nursing, the American Cancer Society, AHIMA, ANA, IBM, and several hospitals.

Technology

A Sweden-based design firm creates GenderEQ, a free iOS app that analyzes the percentage of time males and females speak during a meeting. I like the idea of calling out unintentional gender bias, but the app’s inherent shortcomings are obvious: (a) it may not always identify gender correctly by voice alone, and (b) it is not unreasonable that those of one gender might speak more than the other in a given meeting simply because of who is in the room or what roles they are serving in the meeting. I suggest a companion app that I’ll call TwitEQ, which matches who talked the most with the perception of fellow attendees that their comments were useful. Meeting dynamics encourage everyone to speak up, even those whose comments are of marginal value or relevance, especially in hospitals where too many people are invited and even more show up because they would otherwise feel slighted that decisions would be made without their self-assessed expertise.

Microsoft begins the rollout of Teams, its free workplace collaboration platform and Slack competitor, to Office 365 users. Somehow it’s comforting to see Northwind Traders used as a sample business as Microsoft always does.

Privacy and Security

In New Zealand, a new physician practice system is taken offline when the Ministry of Health discovers that it sends data back to the vendor’s servers in unencrypted sessions.

A hacker who was previously arrested for stealing and selling 62,000 W2 forms of UPMC employees says he will plead guilty.

Denton Heart Group (TX) notifies an unstated number of patients that an unencrypted backup drive was stolen from a locked closet, exposing seven years’ of information.

BJC HealthCare notifies 644 program participants that their information was emailed among its service providers without encryption.

Other

A review of an asthma study conducted using Apple ResearchKit apparently reaches an unexpected conclusion – fickle phone users are just as likely to allow their attention to wander from a clinical study over time as they are their use of any other app, as 6,500 baseline users yielded 2,300 who actively participated and 175 who completed a six-month milestone survey. Still, it’s not easy assembling a study cohort in general, so it’s probably not a bad outcome.

A Slate article ponders whether big data can be applied to predict when someone will die, contrasting the unbiased predictive capability of technology vs. the optimistic, subjective guesses of physicians. A NEJM opinion piece written by a Harvard ED doctor who is working on the technology suggests that the best use of such algorithms is by patients and families who can then make non-healthcare decisions for their remaining time, or as the Slate article concludes, “freeing us from trying to live longer so that we can just live.”

A tiny study performed in a safety net clinic finds that both doctors and patients benefit when patients are given permission to enter topics of concern into the EHR visit note before their arrival.

Three clinicians from University Medical Center (LA) testify that they don’t know who entered a description of “accidental discharge of a gun” in describing the ED treatment of the wife of slain former pro football player Will Smith of the New Orleans Saints. Smith was driving drunk in New Orleans in April 2016 when he rammed the car of another man who then shot several times into Smith’s car, killing Smith and injuring his wife, Raquel. The attorneys of the shooter hope to use the medical record entry to get their client a new trial in claiming that Raquel Smith told the ED staff that her shooting was accidental. The clinicians say the description might have been entered by a medical billing coder who just chose the first available computer dropdown, noting that Raquel Smith’s chart contains another incorrect entry. When asked what Raquel Smith said when she arrived in the ED, the trauma director replied, “Going from memory, I think it was just, ‘I was shot,’ but that was about 900 gunshot wounds ago."”

Weird News Andy questions the wording of a description of a spontaneous breathing trial, which involves cutting back on ventilator breathing assistance to assess the patient’s ability to breathe on their own. WNA challenges this sentence: “If it is not clear that the patient has passed at 120 minutes the SBT should be considered a failure,” wondering if the purpose of the test is to kill the patient.

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Currently there are "20 comments" on this Article:

I’ve implemented Epic 3 times at 3 different organizations and I can say unequivocally that the ROI is always there if you know what you are doing. At my last implementation, we had the biggest charge capture day in the history of the organization in the first week after implementation. You hear about all the horror stories, but those are mostly due to organizational incompetence, not Epic.

RE: Chi-town CIO: I’m guessing that your 3 implementations were moving from non-integrated acute, ambulatory and RCM to fully integrated? If so, there’s your correlation/causation. Also good to know that Epic doesn’t work if you don’t have top shelf IT talent. That’s a fool-proof model for success.

Correct! Several folks missed #4 despite the hype that surrounded Smalltalk in its heyday, probably because the only snippets I could find online weren’t all that representative. The clue was necessary for #1 because at one time, probably 10 companies sold partially xBase compatible products (like Foxpro and Quicksilver) and the language looked the same.

Perfect, although a purist might have insisted on Turbo Pascal or Borland Pascal since Borland developed Delphi but other versions of Pascal existed. Here’s another walk down memory lane: IBM VisualAge. Or for OS/2 fans, Rexx. Surprisingly, Visual COBOL is still available and being used.

Re: HIMSS17 unsolicited follow-ups….I recently received an email from a vendor with a subject line indicating it was a follow-up from our HIMSS conversation, but I didn’t even attend HIMSS. I don’t recall now what company it was; I deleted it with a wry chuckle, without a second glance.

Epic’s recent financially focused research has been flawed since it was based on data sets which are small and biased.

The Moody’s MFRA data set used in Epic’s research includes 414 only non-profit hospitals which means that it excludes a lot of MEDITECH, Cerner and Epic clients and excludes very profitable organizations such as HCA and LifePoint.

The S&P Global data used by Epic in more recent studies includes 9,233 for-profit healthcare entities but only 128 non-profit hospitals. With the majority of all hospitals being non-profit, a study based on this data excludes most of the market.

Most hospitals do not need bond ratings to issue bonds. This is why Moody’s and S&P Global have quality financial information on so few hospitals.

Given the glaring flaws in this recent research, it has been surprising to me that Epic’s non-marketing department has continued using it.

I loved Pascal…. maybe you can ask readers to submit the favorite program they wrote in one of those languages. Mine was a commission from the Dean of the medical school I was attending. I got to write a program to evenly distribute all third year medical students across their 5 rotations (Medicine, Surgery, Ob/Gyne, Peds and Psychiatry).. based on their personal rankings of where they wanted to go for each one (they had to choose from about 4 different hospitals) and which order they wanted (eg Medicine first, Surgery second…). So everyone got a little of what they wanted, no one got everything they wanted. Well, except for me – as I put in an extra line of code to boost my ability to get the order and locations I wanted the most. I think they used it for many years after that. It was my final big computer programming job….and paid for my European vacation after med school ended!

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